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What are Wheelchair Tennis Quads (players with severe disabilities)?
Players in the quads class have a wide range of physical handicaps. This page is about players with neck and spine injuries who account for the majority of players in the quads class. The human spine is made up of 26 (32 - 34) connected vertebrae that form a narrow column. Depending on the location, they are called neck vertebrae, thoracic vertebrae, lumbar vertebrae, sacral vertebrae (sacral spine), and coccyx (caudal vertebra). Neck vertebrae are located at the top of the spine and are made up of seven vertebrae. They have the function of supporting the skull. There is an opening in the spine called the spinal canal that contains the central nerves and spinal cord from the brain. The spinal cord is also divided into sections that correspond to those of the spine: neck cord, thoracic cord, lumbar cord, and sacral cord. The neck cord corresponds to one part of the spine, that in the neck. External injuries or illnesses of the neck can cause damage to the spine called spinal injuries, and of those affecting the neck are called neck spinal injuries. The spine cord has many nerves, and the neck cord has eight pairs of important nerves called the neck nerves. These nerves are usually referred to as C1 to C8 from top to bottom, and each of them is responsible for some of the bodies movements and senses.
Traffic accidents and sports accidents are the most frequent cause of spinal injuries, and the neck vertebrae are the most susceptible to fractures. If the spine is injured, all of the movement and sense functions below the injury are paralyzed. The degree of paralysis differs according to the location of the injury and the damage to the nerves. Some part of the body will be paralyzed regardless of which part of the spine is injured, but injuries to the neck vertebrae will cause paralysis up to the upper limbs; i.e., almost the entire body below the neck will be paralyzed. Therefore, many of these people are not only incapable of handling wheelchairs, but many of them cannot perform basic functions such as eating and drinking. When the injury is close to the head, the breathing muscles may also be paralyzed so that the injured may require an artificial respirator.
In addition, there are cases in which the spine is totally cut called "total paralysis" and partially cut called "incomplete paralysis," so even when referring to "neck cord injuries" there are many different symptoms among patients. It would not be mistaken to say that there are no two patients with the exact same conditions. For total paralysis in which C5 or higher have been injured, playing wheelchair tennis would be very difficult.
Many of the people who have injured their spines cannot perspire, so they are not able to control their body temperatures. When their body temperature rises in summer, it is not rare for them to have body temperatures of 38 to 39 degrees Centigrade. This is not called having a temperature, but a "bout of fever." Conversely, in colder weather, their body temperature may drop too far. This is because spinal injuries prevent automatic nerves from functioning normally. Thorough precautions must be taken for heatstroke during summer matches.
A question that is frequently asked is, "How should we instruct a quad player who has just started to play wheelchair tennis?" Instructors have come up with the following points that must be noted when giving instruction.
Players with weak grips can supplement their handling of their wheelchairs by coating the hand rims with rubber material. There are also some players who use easily available rubber hose in place of rubber coating. If it is difficult for a player to handle a manual wheelchair, they may use powered wheelchairs.
Players with weak grips may tape rackets to their hands or use gloves. Because of the different levels of injury, all players must make their own decisions. All players are trying different things.
Innovations in Practice Methods
- Instructors should talk with the players to determine whether they can change their grip during play or whether they will require a fixed grip. The grip should be adjusted to their level of injury.
- In order for players to find a grip that will let them hit the ball with both their forehand and backhand, and for them to find a good form, they should be fed easy balls with the same rhythm.
- Beginning players should be allowed to get used to "live" balls by practicing doubles.
With regard to players with neck cord injuries, it should be assumed that they are physically weak after their injuries. It is important to allow them plenty of time to practice to build up their strength.
By Hiroshi Tohma (Wheelchair tennis Quads player representing Japan)
Qualifications for Quads Players
In order for a wheelchair tennis player to be eligible to play in official ITF tournaments and the Paralympics, they must be medically diagnosed to have physical disabilities that cause permanent motor function disabilities. The permanent motor function disabilities must be in either or both lower limbs, and they must be partial functional disabilities or total functional disabilities. Players must meet one of the following minimum disability criteria.
A nerve disability that causes motor function disabilities at the S1 (sacral cord 1) level or higher.
Articular rigidity, serious arthritis, or artificial gluteus, knee, or higher ankle joints.
Partial amputation of the lower limbs, including amputation between the toes and ankle.
A functional handicap in one of the lower limbs or on more than one side, and that is applicable to 1, 2 or 3.
Quads players must have a permanent physical handicap that is applicable to one of the above, and they must also be applicable to one of the following:
A nerve handicap at C8 (neck vertebra 8) or higher that also involves a motional function handicap.
An amputated upper limb.
A malformed upper limb.
Upper limb myopathy or muscular dystrophy.
A functional handicap in one of the upper limbs or on more than one side, and that is applicable to 1, 2, 3 or 4.